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How Serious Is Hepatitis B

Diagnosis Of Hepatitis B

Is Hepatitis B dangerous in pregnancy? What is the risk of transmission? – Dr. Shefali Tyagi

Blood tests are available to determine if you are or have been infected with hepatitis B. It may take 6 months from the time of infection before a blood test can detect antibodies to hepatitis B, so follow-up testing may be required. During this 6-month period, until you know whether you are infected or not, take action to prevent potential infection of other people.

There are also tests that can assess liver damage from hepatitis B. The interpretation of these tests can be complicated and specialist advice is needed, so talk to your doctor.

All pregnant women are tested for hepatitis B. If you are found to have chronic hepatitis B, your doctor can help reduce the risk of transferring the infection to your newborn child.

Reduce Your Chance Of Infection

You can reduce your chance of hepatitis B infection by

  • not sharing drug needles or other drug materials
  • wearing gloves if you have to touch another persons blood or open sores
  • making sure your tattoo artist or body piercer uses sterile tools
  • not sharing personal items, such as toothbrushes, razors, or nail clippers
  • using a latex or polyurethane condom during sex

Treatment For Chronic Hbv Infection

For chronic HBV infection, antiviral medications are available.

This is not a cure for chronic HBV. However, it can stop the virus from replicating and prevent its progression into advanced liver disease.

A person with a chronic HBV infection can develop cirrhosis or liver cancer rapidly and without warning. If a person does not have access to adequate treatment or facilities, liver cancer can be fatal within months of diagnosis.

People with a chronic HBV infection require ongoing medical evaluation and an ultrasound of the liver

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How Is Hepatitis B Transmitted

Hepatitis B is spread in several distinct ways: sexual contact sharing needles, syringes, or other drug-injection equipment or from mother-to-child at birth.

In the United States, in 2018, injection drug use was the most common risk factor reported among people with an acute HBV infection, followed by having multiple sex partners. Less commonly reported risk factors included accidental needle sticks, surgery, transfusions, and household contact with a person with HBV infection. In the United States, healthcare-related transmission of HBV is rare.

Mother-to-child transmission of HBV is especially concerning, because it is preventable. An estimated 25,000 infants are born to mothers diagnosed with HBV each year in the United States, and approximately 1,000 mothers transmit HBV to their infants. Without appropriate medical care and vaccinations, 90% of HBV-infected newborns will develop chronic infection, remaining infected throughout their lives. Up to 25% of people infected at birth will die prematurely of HBV-related causes. For this reason, the standard of care for pregnant women includes an HBV test during each pregnancy so that the appropriate steps can be taken to prevent HBV-positive mothers from transmitting the disease to her infant.

What Are The Symptoms Of Hepatitis B

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Up to half of people age 5 years and older develop symptoms from acute hepatitis B infection. Some people who have hepatitis B, especially younger kids and those with serious health problems , do not have symptoms. In a small number of acute hepatitis B infections, the person dies very quickly.

If symptoms occur, they can appear anywhere from 8 weeks to 5 months after exposure. Symptoms usually last several weeks, but some people can be acutely sick for as long as 6 months.

The symptoms of acute hepatitis B include:

  • Lack of energy
  • Pale stool
  • Jaundice

Although most infected people recover completely, some develop chronic, long-term hepatitis B and can spread the infection. Most people with chronic hepatitis B do not have any symptoms, do not feel ill, and can remain symptom free for decades. If a person with chronic hepatitis B does have symptoms, they will be similar to the symptoms of acute infection, but symptoms can be a sign of advanced liver disease. Some people still do not have symptoms even as the liver becomes diseased, but certain blood tests for liver function will show that something is not right.

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Prevalence Of Hbv Infection In Canada

The prevalence of HBV infection may vary among population subgroups in Canada. In previous studies of selected populations in Canada, HBsAg seroprevalence rates were estimated to be between 0.24% to 0.47% in people aged 14 to 30 years from a Northern Ontario town Footnote 3. These rates were estimated to be 5% to 15% in adults from Southeast Asia Footnote 4, and 0.1% to 0.5% in Canadian first-time blood donors Footnote 5. In a 1995 survey of 1200 school children aged 8 to 10 years in Québec, none were found to be positive for HBsAg, or antibody to the HBV core antigen Footnote 6.

Who Is At Risk For Hepatitis B

Anyone can get hepatitis B, but the risk is higher in:

  • Infants born to mothers who have hepatitis B
  • People who inject drugs or share needles, syringes, and other types of drug equipment
  • Sex partners of people with hepatitis B, especially if they are not using latex or polyurethane condoms during sex
  • Men who have sex with men
  • People who live with someone who has hepatitis B, especially if they use the same razor, toothbrush, or nail clippers
  • Health care and public-safety workers who are exposed to blood on the job

If you have chronic hepatitis B, you may not have symptoms until complications develop. This could be decades after you were infected. For this reason, hepatitis B screening is important, even if you have no symptoms. Screening means that you are tested for a disease even though you don’t have symptoms. If you are at high risk, your health care provider may suggest screening.

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Questions To Ask Your Doctor

  • How did I get hepatitis B?
  • What treatment is best for me?
  • Can I be cured of hepatitis B?
  • Are there any medicines I should take?
  • What can I do to protect my friends and family from hepatitis B?
  • How long will my treatment last?
  • Is it possible for hepatitis B to come back?
  • Should I get the hepatitis B vaccine?
  • What are the side effects of antiviral medicines?
  • Will my liver ever be normal again?

Guidance On Reporting Adverse Events Following Immunization

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Vaccine providers are asked to report, through local public health officials, any serious or unexpected adverse event temporally related to vaccination. An unexpected AEFI is an event that is not listed in available product information but may be due to the immunization, or a change in the frequency of a known AEFI.

Refer to Reporting Adverse Events Following Immunization in Canada and Adverse events following immunization in Part 2 for additional information about AEFI reporting.

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Who Should Get The Hepatitis B Vaccine

All newborn babies should get vaccinated. You should also get the shot if you:

  • Come in contact with infected blood or body fluids of friends or family members
  • Use needles to take recreational drugs
  • Have sex with more than one person
  • Are a health care worker
  • Work in a day-care center, school, or jail

Symptoms Of Hepatitis B

Many people with hepatitis B will not experience any symptoms and may fight off the virus without realising they had it.

If symptoms do develop, they tend to happen 2 or 3 months after exposure to the hepatitis B virus.

Symptoms of hepatitis B include:

  • flu-like symptoms, including tiredness, a fever, and general aches and pains
  • loss of appetite
  • tummy pain
  • yellowing of the skin and eyes

These symptoms will usually pass within 1 to 3 months , although occasionally the infection can last for 6 months or more .

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Routine Minimum Hbv Surveillance In Canada

HBV infection has been reportable through the Canadian Notifiable Disease Surveillance System since 1969. Physicians are required to report clinically diagnosed HBV infection cases to their local health authority. Cases that meet the HBV infection surveillance case definition are officially reported to P/T public health authorities Footnote 15. Local laboratories are also required to report laboratory-confirmed HBV infection cases to provincial laboratories, which in turn report the cases to both local and P/T public health authorities. Aggregate data on HBV infection from all P/Ts are sent to the Public Health Agency of Canada on a regular basis. However, reporting practices across P/Ts remain inconsistent because some jurisdictions report only acute HBV infection cases, while others report acute and indeterminate HBV infection cases together. Since 2004, chronic HBV infection cases are also being reported by some P/Ts. Efforts to investigate and remove duplicate HBV infection cases vary across jurisdictions. In addition, risk factor information is not collected, and the case-by-case reporting utilized by some P/Ts does not contain standardized data elements.

The rate of reported acute and indeterminate HBV infection cases decreased in all age groups, particularly among age groups for whom recommendations for routine vaccination have applied.

Table 1. Number and rates of reported acute, indeterminate and chronic/carrier HBV infection cases in Canada, CNDSS, 1990-2008*

Year

Acute Vs Chronic Hepatitis B

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A hepatitis B infection can result in either an acute infection or a chronic infection. When a person is first infected with the hepatitis B virus, it is called an “acute infection” . Most healthy adults that are infected do not have any symptoms and are able to get rid of the virus without any problems. Some adults are unable to get rid of the virus after six months and they are diagnosed as having a “chronic infection.” A simple blood test can diagnose an acute or chronic hepatitis B infection.

The risk of developing a chronic hepatitis B infection is directly related to the age at which a person is first exposed to the hepatitis B virus. The younger a person is when they are first infected, the greater the risk of developing a chronic hepatitis B infection:

  • More than 90% of infants that are infected will develop a chronic hepatitis B infection
  • Up to 50% of young children between 1 and 5 years who are infected will develop a chronic hepatitis B infection
  • 5-10% of healthy adults 19 years and older who are infected will develop a chronic hepatitis B infection

The recommendation for hepatitis B vaccination of babies and children is so important because they are at the greatest risk of developing a chronic infection if they are not protected against the hepatitis B virus as soon as possible.

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What Treatments Are Available For Chronic Hepatitis B If Medications Dont Work

If you have advanced hepatitis B, you might also become a candidate for a liver transplant. This path does not always result in a cure because the virus continues in your bloodstream after a transplant. To prevent being infected again after your transplant, you may be prescribed hepatitis B immunoglobulin with an antiviral agent.

Common And Local Adverse Events

HB vaccine

HB vaccine is well tolerated. Reactions are generally mild and transient, and include: irritability, headache, fatigue and injection site reactions in 10% or more of recipients.

HAHB vaccine

There is no increase in adverse events when HAHB vaccine is compared with HA vaccine given alone or concomitantly with HB vaccine at a different injection site. When the adult formulation of HAHB vaccine is given to children in the 2 dose schedule, there is no increase in adverse events compared with those occurring after administration of the pediatric formulation of HAHB vaccine.

DTaP-HB-IPV-Hib vaccine

Reactions are usually mild and transient, and include fever, irritability, restlessness and injection site reactions .

HBIg

Headache, diarrhea, fever, urticaria, angioedema and injection site reactions may occur.

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Risks Of Hepatitis B Exposure

Like HIV, HBV can be spread through contact with infected blood or body fluids. The most common ways of being infected with HBV are:

  • Sexual contact with an infected partner. Those most at risk are those who have multiple sexual partners, especially in areas where HBV is common.
  • Sharing needles, straws, pipes, spoons, cookers, and other drug equipment. Cleaning equipment with bleach may not kill the virus.
  • Tattooing, body piercing, or acupuncture when non-sterile equipment or techniques are used.
  • Being born to a mother with HBV.
  • Being exposed in the workplace by getting pricked by a needle or sharp equipment that has infected blood on it.

What Is Hepatitis

Is Hepatitis B dangerous in pregnancy ?What is the risk of transmission ? I Cloudnine Hospitals

Hepatitis is a general term for inflammation of the liver. Normally, the liver breaks down waste products in your blood. But when the liver is inflamed, it doesnt do a good job of getting rid of waste products. This causes waste products to build up in your blood and tissues.

Many different things can cause hepatitis. The most common cause of hepatitis is infection with one of the 5 hepatitis viruses . Other potential causes are:

  • Lack of blood supply to the liver.
  • Poison.
  • An injury to the liver.
  • Taking certain medications.
  • Viral infections, such as mononucleosisor cytomegalovirus, although this is less common.

There are 2 main kinds of hepatitis: acute hepatitis and chronic hepatitis . Most people get over the acute inflammation in a few days or a few weeks. Sometimes, however, the inflammation doesnt go away. When the inflammation doesnt go away in 6 months, the person has chronic hepatitis.

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How Did I Get It

There are several ways of getting hepatitis B. One way is by sexual contact with an infected person.

Hepatitis B virus is transmitted through blood and body fluids especially through anal sex. Other ways are by sharing personal items , and sharing needles or equipment for injection drug use. Healthcare and emergency service workers can get it through needle stick injuries or blood splashes in the eyes, nose, mouth or on broken skin.

How Hepatitis B Is Spread

The hepatitis B virus is found in the blood and bodily fluids, such as semen and vaginal fluids, of an infected person.

It can be spread:

  • from a mother to her newborn baby, particularly in countries where the infection is common
  • within families in countries where the infection is common
  • by having sex with an infected person without using a condom
  • by having a tattoo, body piercing, or medical or dental treatment in an unhygienic environment with unsterilised equipment

Hepatitis B is not spread by kissing, holding hands, hugging, coughing, sneezing or sharing crockery and utensils.

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What Are Clinical Trials For Hepatitis B

Clinical trialsand other types of clinical studiesare part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of hepatitis B, such as

  • progression of hepatitis B and long-term outcomes
  • new treatments for hepatitis B
  • prevention of reactivated or worsening hepatitis B in people receiving cancer treatment

Hepatitis B During Pregnancy

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If a woman with HBV becomes pregnant, they may transmit the virus to their baby. Women should inform the doctor who delivers their baby that they have HBV.

The infant should receive an HBV vaccine and HBIG with 1224 hours of birth. This significantly reduces the risk that they will develop HBV.

The HBV vaccine is safe to receive while pregnant.

People with a high risk of HBV include:

  • the infants of mothers with HBV
  • the sexual partners of people with HBV
  • people who engage in sexual intercourse without contraception and those who have multiple sexual partners
  • men who have sex with men
  • people who inject illicit drugs
  • those who share a household with a person who has a chronic HBV infection
  • healthcare and public safety workers who are at risk of occupational exposure to blood or contaminated bodily fluids
  • people receiving hemodialysis, which is a type of kidney treatment
  • people taking medications that suppress the immune system, such as chemotherapy for cancer
  • those who come from a region with a high incidence of HBV
  • all women during pregnancy

People can prevent HBV infection by:

  • wearing appropriate protective equipment when working in healthcare settings or dealing with medical emergencies
  • not sharing needles
  • following safe sexual practices
  • cleaning any blood spills or dried blood with gloved hands using a 1:10 dilution of one part household bleach to 10 parts water

A vaccine against HBV has been available since 1982.

People who should receive this vaccine include:

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What Are The Risk Factors For Getting Hepatitis B

Due to the way that hepatitis B spreads, people most at risk for getting infected include:

  • Children whose mothers have been infected with hepatitis B.
  • Children who have been adopted from countries with high rates of hepatitis B infection.
  • People who have unprotected sex and/or have been diagnosed with a sexually transmitted infection.
  • People who live with or work in an institutional setting, such as prisons or group homes.
  • Healthcare providers and first responders.
  • People who share needles or syringes.
  • People who live in close quarters with a person with chronic hepatitis B infection.
  • People who are on dialysis.

Who Are Hepatitis B Carriers

Hepatitis B carriers are people who have the hepatitis B virus in their blood, even though they dont feel sick. Between 6% and 10% of those people whove been infected with the virus will become carriers and can infect others without knowing it. There are over 250 million people in the world who are carriers of HBV, with about 10% to 15% of the total located in India. Children are at the highest risk of becoming carriers. About 9 in 10 babies infected at birth become HBV carriers, and about half of children who are infected between birth and age 5 carry the virus. A blood test can tell you if you are a hepatitis B carrier.

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